Psychological and behavioral profiles of combustible vs. e-cigarette users: a narrative review of the implications for tailored non-pharmacological cessation interventions

Background and aim: The decline in combustible cigarette use along with the rapid rise in e-cigarette use necessitates differentiated cessation strategies for each. This narrative review compares psychological, behavioral, and intervention-related characteristics between combustible cigarette users (CCUs) and e-cigarette users (ECUs). Methods: A structured literature search (2010-2025) of PubMed, Scopus, Embase, and Google Scholar identified 76 representative studies that examined the psychological, behavioral, and intervention-related characteristics of CCUs and ECUs. Results: CCUs and ECUs may demonstrate distinct dependence patterns and motivational profiles. CCUs tend to exhibit physiological withdrawal and conditioned automaticity, responding best to structured, high-intensity interventions that combine cognitive behavioral therapy with pharmacotherapy. ECUs appear to show reinforcement and lower risk perception, demonstrating greater engagement with digital interventions featuring gamification, peer components, and flexible goal-setting. Discussion: Effective tobacco control requires a user-specific strategy. For CCUs, multicomponent approaches that emphasize complete cessation, relapse prevention, and withdrawal management are essential. Digital platforms with stepwise goals, peer-based strategies, and cognitive reframing of perceived control are more effective for ECUs. Age-tailored approaches and their systematic integration into healthcare systems are critical for implementation. The findings identify priorities for future intervention research and implementation, and inform a differentiated behavioral framework for tailoring non-pharmacological cessation strategies to CCUs and ECUs.